Practicing on the verge: Nurse practitioner capability development in the care of individuals with opioid use disorder

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Whitfield, Martha M.
capability , nurse practitioners , advanced practice nursing , phenomenography , opioid use disorder
Nurse practitioner treatment of opioid use disorder in North America has been made possible by changes to prescriptive authority over the past decade and necessitated by the ongoing opioid overdose and poisoning epidemic. As advanced practice nurses, nurse practitioners have traditionally been evaluated using competency-based models. While competency-based education delineates measurable activities and skills, capability has the potential to describe advanced practice nursing within complex clinical settings, especially because the term is inclusive of variation in practice environment. For this thesis I aimed to clarify how capability is described in the global literature about advanced practice nursing and education (Phase 1), and to explore how nurse practitioners experienced capability development in the context of treatment of opioid use disorder (including safe supply) in primary care settings (Phase 2). I conducted a scoping review using the JBI methodology, followed by a phenomenographic study with a purposive sample of 21 nurse practitioners treating opioid use disorder in Canada and the United States. Finally, I synthesized findings from the phenomenographic study in the context of the scoping review results (Phase 3). Nurse practitioners experienced capability development as a process of knowledge acquisition, knowledge integration, evolving practice perspectives, practice adaption, and becoming expert. Although capability is described variously, there was congruence between what is written in the literature and results of the phenomenographic study, including the ability of nurse practitioners to critically evaluate clinical scenarios, identify knowledge gaps, and provide creative leadership to address care needs. Understanding capability in the context of opioid use disorder treatment has the potential to provide greater self-understanding for nurse practitioners and a clearer framework for articulating nurse practitioner contributions to the opioid overdose crisis to regulators, policy makers, and the public.
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